TN 21 (12-18)

DI 23022.820 Medulloblastoma

COMPASSIONATE ALLOWANCE INFORMATION

MEDULLOBLASTOMA

ALTERNATE NAMES

DESCRIPTION

Medulloblastoma is a rare type of malignant brain cancer that occurs in the cerebellum and adjacent tissue (which control body movement and coordination). Medulloblastomas are primarily a type of childhood brain cancer, and rarely occur in adults.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING

Diagnostic testing: The diagnosis of a medulloblastoma is made by:

• Imaging tests including MRI of the brain and spine; CT, PET scan, and radionuclide bone scans;

• A spinal tap may be performed to obtain cerebral spinal fluid to search for cancer cells or tumor markers; and

• Analysis of the tumor after surgical resection confirms the diagnosis of medulloblastoma.

Physical findings: Individuals with a medulloblastoma may present with:

• Headaches which are often worse in the morning and get better during the day;

• Nausea or vomiting in the morning;

• Problems with motor skills, such as clumsiness or poor handwriting;

• Tiredness/Fatigue;

• Tilting the head to one side;

• Double vision (diplopia);

• Rapid, jerky eye movements (nystagmus);

• Facial weakness;

• Ringing in the ears (tinnitus);

• Hearing loss;

• Stiff neck;

• Back pain; and

• Inability to control bladder and bowel functions.

ICD-9: 191.6

PROGRESSION

Prognosis is poor for medulloblastoma.

TREATMENT

Surgery alone does not cure this type of cancer. Chemotherapy and radiation are often used in combination with surgery.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

• Clinical history and examination that describes the diagnostic features of the impairment;

• Pathology/biopsy report of the cancer;

• If a pathology report is unavailable, a surgical report or all radiological studies (for example, MRI and CT scans) and treatment notes indicating antineoplastic therapy for metastases may be substituted; and

• If available, spinal tap results.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.13 A 2

 

Medulloblastoma meets the criteria in listing 13.13 A 2 upon confirmed diagnosis, regardless of the effectiveness of treatment.

113.13B

Medulloblastoma meets the criteria in listing 113.13 B upon confirmed diagnosis, regardless of the effectiveness of treatment.

Equals

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022820
DI 23022.820 - Medulloblastoma - 12/28/2018
Batch run: 12/28/2018
Rev:12/28/2018